Deterioration

Acute deterioration includes physiological, psychological and cognitive changes that indicate a worsening of the patient’s health status, which may occur over hours or days.

Deterioration

Communicating acute deterioration and escalating care

Communication is fundamental to the prompt identification, escalation and management of acute deterioration. It is important that health service organisations have processes in place to support the workforce, patients, families and carers to rapidly access the services they need when an episode of clinical deterioration occurs. Effective teamwork and communication, including documentation, of diagnosis and plans for monitoring of observations and ongoing management is crucial to providing safe, high-quality care to the deteriorating patient.

Key messages

  • Timely and effective communication about a patient’s deterioration to the right person (or people) is essential for patient safety
  • Patients and their support people are well placed to identify signs of acute deterioration. Their concerns about possible deterioration are valuable and should be acted on by clinicians
  • A person who has previously experienced deterioration in mental state typically has a good understanding of specific factors that can precipitate deterioration for them. The person’s own awareness can support early recognition of deterioration
  • Discussions with the patient (or substitute decision-maker, if appropriate) about their wishes for advance care planning, resuscitation and active treatment can be undertaken by any member of the health care team. This should be communicated adequately to the treating team and incorporated into a resuscitation plan. 
  • Communication related to acute deterioration can be greatly improved using an agreed structured protocol or mnemonic. Structured protocols or mnemonics enable clinicians, trained in their use, to recall important information, reduces the likelihood of information being missed, and helps clinicians communicate information in a clear, logical and precise manner.

Mnemonic: memory device that help to recall larger pieces of information, especially in the form of lists such as characteristics, steps, stages, parts or phases. They can include acronyms and rhymes. Examples include ISBAR, ISoBAR, SHARED.

Communication Strategies

Why is this important?

Effective clinical communication about patient deterioration is a complex process. It includes knowing when and who to contact if a patient’s condition deteriorates, what information is important to convey, and how to convey this information effectively.

Some of the most important contributing factors to adverse events in health care are lack of handover processes, insufficient or poor communication techniques during handover, and inadequate clinical documentation. 

Information that is important for recognising and responding to acute deterioration may be overlooked during clinical handover. Poor communication also poses risks to patient safety when patients are transferred between clinical areas, and during critical events such as rapid response system callsPoor verbal and written communication between clinicians can result in discontinuity of care, delays in treatment, adverse events, and increased morbidity and mortality. Practices such as not reading documentation may also contribute to adverse events and acute deterioration not being recognised and acted on. 

It is important to develop agreed communication processes (written and verbal) and train staff to use standardised practices to improve team performance and ensure that the correct information is conveyed at the right time, to the right person, for the right reasons.

Patients can experience delays in receiving the treatment they need if agreed communication processes are not in place.

Taking action: What is my role?